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Journal ID (publisher-id): OJPHI
ISSN: 1947-2579
Publisher: University of Illinois at Chicago Library
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©2013 the author(s)
open-access: This is an Open Access article. Authors own copyright of their articles appearing in the Online Journal of Public Health Informatics. Readers may copy articles without permission of the copyright owner(s), as long as the author and OJPHI are acknowledged in the copy and the copy is used for educational, not-for-profit purposes.
Electronic publication date: Day: 4 Month: 4 Year: 2013
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Volume: 5E-location ID: e145
Publisher Id: ojphi-05-145

Using Medications Sales from Retail Pharmacies for Syndromic Surveillance in Rural China
Weirong Yan*12
Liwei Cheng2
Li Tan2
Miao Yu3
Shaofa Nie2
Biao Xu3
Lars Palm4
Vinod Diwan1
1Karolinska Institutet, Stockholm, Sweden;
2Huazhong University of Science and Technology, Wuhan, China;
3Fudan University, Shanghai, China;
4Future Position X, Gavle, Sweden
*Weirong Yan, E-mail:


To use an unconventional data - pharmaceutical sales surveillance for the early detection of respiratory and gastrointestinal epidemics in rural China.


Drug sales data as an early indicator in syndromic surveillance has attracted particular interest in recent years (1, 2), however previous studies were mostly conducted in developed countries or areas. In China, many people (around 60%) choose self-medication as their first option when they encounter a health problem (3), and electronic sales information system is gradually used by retail pharmacies, which makes drug sales data become a promising data source for syndromic surveillance in China.


This experimental study was conducted in four rural counties in central China. From Apr. 1st 2012, there are 56 retail pharmacies joined the study, including 21 county pharmacies and 35 township pharmacies. 123 drugs were selected under surveillance based on the analysis of local historical sales volume and consultation with local pharmacists, including 19 antibiotics, 15 antidiarrheal medications, 9 antipyretics, 41 compound cold medicine, and 39 cough suppressants. Daily sales volume of the selected drugs was recorded into the database by pharmacy staff at each participating unit via electronic file importing or manual entering. Figure 1 showed the user interface for data viewing, query and export. Field training and supervision were regularly conducted to ensure the data quality.


From Apr. 1st to Jun. 30th 2012, there were 103814 sales records reported in the system, including 44464 (42.83%) records from county pharmacies and 59350 (57.17%) from township pharmacies. Among all surveillance drugs, the sales of compound cold medicine accounted for the largest proportion (43.42%), followed by antibiotics (22.52 %), cough suppressants (18.50%), antidiarrheal drugs (9.49%) and antipyretics (6.06 %). More than 80% data were reported into the system within 24 hours after the sales date, and the reporting timeliness of county pharmacies improved with time (table 1). Missing report rate was less than 5% for all surveillance units. Several reporting mistakes were found during the first three-month implementation, which might be due to system bugs, data provider unfamiliar with the system especially when manual reporting, data providers’ carelessness, and some pharmacies reluctant to share sales data amongst others.


Although the current reporting timeliness and completeness are satisfying, it is noteworthy the quality of data is not stable during the beginning phase of the implementation. Further validation of the data will be required. To ensure the accuracy of data and the effective and sustainable deployment of the system, it is imperative to establish a data sharing policy between pharmacies and public health agencies, and achieve automated data collection to avoid additional human labor involvement.


The study is financially supported by a grant under the European Union Framework Program 7 (project no: 241900).

1.. Magruder S. Evaluation of over - the - counter pharmaceutical sales as a possible early warning indicator of human diseaseJohns Hopkins APL technical digest 2003;24(4):349–53.
2.. Das D, Metzger K, Heffernan R, Balter S, Weiss D, Mostashari F. Monitoring over-the-counter medication sales for early detection of disease outbreaks—New York CityMMWR 2005;54(Suppl):41–6.
3.. Wen Y, Lieber E, Wan D, Hong Y, NIMH Collaborative HIV/STD Prevention Trial GroupA qualitative study about self-medication in the community among market vendors in Fuzhou, ChinaHealth Soc Care Community 2011;19(5):504–13.

[Figure ID: f1-ojphi-05-145]
Figure 1 

User interface in the system for data viewing, query and export

[TableWrap ID: t1-ojphi-05-145] Table 1: 

Timeliness of reporting records from various pharmacies, Apr. 1st –Jun. 30th, 2012

Report time after sales date April May June
County N(%) Township N(%) County N(%) Township N(%) County N(%) Township N(%)
within 24 h 11359(75.84) 16653(85.6) 12483(81.80) 17749(87.99) 12225(85.93) 15977(81.01)
24 h-48h 1523(10.25) 1001(5.15) 1487(9.74) 1760(8.72) 1321(9.29) 2224(11.28)
later than 48h 2084(13.91) 1801(9.26) 1290(8.45) 663(3.29) 680(4.78) 1522(7.72)
Sum 14978 19455 15260 20172 14226 19723

Article Categories:
  • ISDS 2012 Conference Abstracts

Keywords: Syndromic surveillance, Medication sales, Developing settings.